Prostate biopsies and effects on erectile function post-biopsy

There have long been suggestions that having a prostate biopsy could be associated with at least a temporary decline in erectile function. A new study in BJU International has now shed more light on this matter.

Murray et al. carried out a prospective study among > 200 men who underwent a TRUS-guided prostate biopsy at the University of Kansas Medical Center and the Kansas City Veterans Administration Medical Center. The paper is also discussed on the Renal & Urology News web site.

All patients were asked to complete a five-item version of the International Index of Erectile Function (IIEF-5) and the International Prostate Symptom Score (IPSS) before their biopsy and at 1, 4 and 12 weeks thereafter.

Here is what Murray et al. report:

  • The study enrolled a total of 220 men, with an average (mean) age of 64.1 years and an average (mean) PSA level of 6.7 ng/dl.
  • At initial presentation,
    • 38.6 percent of patients reported no erectile dysfunction (ED).
    • 22.3 percent of patients reported mild ED.
    • 15.5 percent of patients reported mild-to-moderate ED.
    • 100 percent of patients reported moderate ED.
    • 13.6 percent of patients reported severe ED.
  • On post-biopsy follow-up, compared to ED at initial presentation, there were statistically significant reductions in IIEF-5 score over time,
    • From 18.2 to 15.5 at 1 week (P < 0.001).
    • From 18.4 to 17.3 at 4 weeks (P = 0.008)
    • From 18.4 to 16.9 at 12 weeks (P = 0.004)

Note that the number of patients completing the follow-up questionnaires decreased at each time point (163 at 1 week, 126 to 4 weeks, and 103 at 12 weeks). This explains why there is some variation in the baseline mean IIEF-5 score at each time-point.

Murray et al. conclude that:

The effects of TRUS-guided prostate biopsy on erectile function have probably been underestimated. It is important to be aware of these transient effects so patients can be appropriately counseled. The exact cause of this effect is yet to be determined.

They also state that

ED, acute or sub-acute, should be discussed with the patients before biopsy because biopsy has been shown to affect erections in men at many time-points after biopsy.

Now it is important to appreciate that this decrease in erectile function is almost certainly not all consequent to anatomical and physiological effects. Potential causes probably include psychogenic issues, fear of results, and anxiety related to biopsy, as well as such anatomical considerations such as nerve damage and hematoma. Longer-term impact on erectile function could also be associated  with other factors, including advancing age, psychological stress, and/or and actual diagnosis of prostate cancer (even if no treatment has been administered).

Men are highly sensitive — emotionally and psychologically, as well as physically — to any form of invasive procedure carried out on their urogenital system, and a prostate biopsy is very definitely an invasive procedure! It is therefore not surprising that many men — and particularly men > 60 years of age who may already have declining erectile function for all sorts of other reasons — find that a prostate biopsy can lead to some greater degree of ED, particularly over the next few weeks. However, it is also imperative for the medical community to learn to warn patients about this. If you know to expect it and that it is likely to be temporary, then as a patient you will be less worried when it happens and therefore more likely to get past the temporary problem with a minimum of angst!

2 Responses

  1. Excellent information. Thank you.

  2. Doesn’t surprise me. If erection is followed by ejaculation, as it often/sometimes is, and that ejaculate is bloody, that is off-putting in itself.

    An interesting implication of this study is that a treatment regime that involves repeated biopsies is not without effect in long-term erectile function.

    I regard my one-time biopsy as one of the more traumatic episodes in my life and am glad that the subsequent prostatectomy means that I won’t have to have another one.

    During my treatment I took part in a UK-based study which was aiming to use MRI for diagnostic purposes and if this ultimately reduces the number of biopsies performed it will be a very good thing.

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